Transvaginal, ultrasound‐guided, ovarian, interstitial laser treatment in anovulatory women with clomifene‐citrate‐resistant polycystic ovary syndrome

Abstract

Objective To assess the effectiveness of transvaginal, ultrasoundguided, ovarian, interstitial laser coagulation treatment in anovulatory women with polycystic ovary syndrome (PCOS).Design A pilot study.Setting Assisted reproductive technology unit.Sample Twenty-three anovulatory women with clomifenecitrate-resistant PCOS.Methods Ultrasound-guided, transvaginal, ovarian, interstitial yttrium-aluminium-garnet laser treatment.Main outcome measures Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin and estradiol levels, spontaneous ovulation rate and pregnancy rate were measured over 6 months of follow up.Results Regular ovulation occurred in 19 out of 22 (86.4%) women in the 6 months following ovarian treatment (one woman was lost to follow up). On the postoperative second, fourth and sixth month, the mean serum LH levels were 4.54 SD 1.21 iu/l, 4.90 SD 2.18 iu/l and 4.42 SD 1.03 iu/l, significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative level of 13.89 ± 3.62 iu/l; the mean serum testosterone levels were 2.69 SD 1.83 nmol/l, 2.42 SD 1.11 nmol/l and 2.28 SD 1.96 nmol/l and significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative baseline value of 5.37 SD 3.09 nmol/l; the mean LH/FSH ratios of 0.93 SD 0.26, 0.88 SD 0.17 and 0.81 SD 0.14 were also significantly lower than the preoperative value of 2.78 SD 1.21 (P < 0.001). Pregnancy occurred in eight women and there was a cumulative pregnancy rate at 6 months of 36% (8/22) among the subjects. There were no significant operative complications.Conclusion Ultrasound-guided, transvaginal, ovarian, interstitial laser treatment appears effective in improving hormonal profiles and inducing ovulation and successful pregnancy in women with clomifene-resistant PCOS.

Transvaginal ultrasound-guided ovarian interstitial laser treatment in anovulatory women with polycystic ovary syndrome: a randomized clinical trial on the effect of laser dose used on the outcome

“…The number of punctures have varied markedly between three and 25 per ovary with power settings between 30 and 400 W (2, 6). Such a wide range of puncture points made in an ovary with different outcomes in different studies can be explained by the variation in techniques used in laparoscopic ovarian diathermy, including [1] using different instruments (e.g., needles, scissors, biopsy forceps) to deliver the energy to the ovary; [2] applying a different amount of energy to the ovary (measured in joules, equivalent to power in watts multiplied by the duration of electricity applied in s per puncture); and [3] distribution of the thermal energy, either localized to a few holes or more widely spread over many holes with varying depths of penetration. Therefore, it is important that the comparison between different studies of laparoscopic ovarian diathermy should take into consideration the total amount of thermal energy delivered to each ovary, not just the number of holes made in the ovary.…”

“…The procedure of transvaginal ultrasound-guided ovarian interstitial laser treatment has been detailed previously (1). All participants were treated on the third day after P-induced bleeding.…”

“…In 2005, we designed and evaluated the effectiveness of the transvaginal ultrasound-guided ovarian interstitial laser treatment in 23 anovulatory women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) as a new method of ovulation induction in infertile women with PCOS, with a >80% ovulation rate and 36% pregnancy rate during 6 postoperative months (1). However, just as the technique of laparoscopic ovarian diathermy or drilling applied in the management of anovulatory women with CC-resistant PCOS, in which a satisfactory treatment result usually associates with the appropriate number of punctures made, power setting, and duration of each puncture (2)(3)(4)(5)(6), an optimal outcome of ovarian interstitial laser treatment also depends on the appropriate number of intraovarian laser coagulation points.…”

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

“…Some techniques of transvaginal ovarian drilling have been described in elegant studies [7,8], nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation [9], seems to be an easier and feasible approach [10]. …”

Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?

“…As a conclusion, although this new technique described by Zhu et al (1)(2)(3) seems to be a promising novel treatment method, it has not yet been investigated thoroughly, and further studies for its efficacy and safety should be undertaken.…”